经尿道前列腺切除术后并发导尿管相关膀胱刺激征的风险预测列线图模型构建研究

Construction study of a nomogram model for risk prediction of catheter-related bladder discomfort after transurethral resection of prostate

目的探讨经尿道前列腺切除术(TURP)后并发导尿管相关膀胱刺激征(CRBD)的危险因素,并构建风险预测列线图模型。方法回顾性分析2020年1月至2022年2月海南省人民医院收治的246例行TURP治疗的患者的临床资料。根据术后是否并发CRBD将其分为并发组(n=148)和未并发组(n=98)。分析TURP后并发CRBD的影响因素,并建立风险预测列线图模型。结果TURP后并发CRBD的影响因素包括年龄>65岁、麻醉后留置导尿管、药物催醒、术后尿路感染、使用氯胺酮/艾司氯胺酮类药物、使用抗胆碱能药物(P<0.05);基于上述影响因素构建列线图模型,根据列线图低、中、高风险临界值分为TURP后并发CRBD低、中、高风险(<79.63分、79.63~160.23分、>160.23分);受试者工作特征(ROC)曲线分析显示,列线图预测TURP后并发CRBD的曲线下面积(AUC)为0.810(95%CI:0.756~0.857);采用Bootstrap自抽样法内部验证的一致性指数为0.798,该列线图模型区分度良好;校准曲线与标准曲线贴合较好。结论年龄>65岁、麻醉后留置导尿管、药物催醒、术后尿路感染、使用氯胺酮/艾司氯胺酮类药物、使用抗胆碱能药物均是TURP后并发CRBD的影响因素,据此构建的风险列线图模型具有良好的准确度、区分度和预测效果。

Objective To explore the risk factors of concurrent catheter-related bladder discomfort(CRBD)after transurethral resection of prostate(TURP),and to construct a nomogram model for risk prediction.Methods The clinical data of 246 patients with TURP in Hainan General Hospital from January 2020 to February 2022 were retrospectively analyzed,and the patients were divided into concurrent group(n=148)and non-concurrent group(n=98)according to whether they were complicated with CRBD after operation.The influencing factors of CRBD after TURP were analyzed,and a nomogram model for risk prediction was constructed.Results The influencing factors of postoperative CRBD after TURP included age65,indwelling catheter after anesthesia,drug arousal,postoperative urinary tract infection,use of ketamine/esketamine and anticholinergic drugs(P0.05).Based on the above influencing factors,a nomogram model for risk prediction of CRBD after TURP was constructed,and CRBD after TURP were divided into low,medium and high risk of postoperative CRBD after TURP(79.63 points,79.63-160.23 points,160.23 points)according to the low,medium and high risk threshold of the nomogram.The receiver operator characteristic(ROC)curve analysis showed that the area under the curve(AUC)of nomogram for predicting CRBD after TURP was 0.810(95%CI:0.756-0.857).The consistency index of internal verification by bootstrap self-sampling method is 0.798,and the nomogram model has good discrimination,and the calibration curve fits well with the standard curve.Conclusions Age 65,indwelling catheter after anesthesia,drug wake-up,postoperative urinary tract infection,use of ketamine/esketamine and anticholinergic drugs are all the influencing factors of postoperative CRBD after TURP.The accordingl-constructed risk nomogram model has good accuracy,differentiation,and prediction effect.